Biomedical subjects
Publications and source records attributed to G Janvier.
The authors report their experience with the use of a semi-conscious anesthetic technique for translumbar angiography of the abdominal aorta by the means of diazepam neurolept analgesia. This technique permits gathering all the data necessary for the angiographic examination. It is easy to manipulate and enables a certain comfort for asthenic patient.
(1) Late thrombosis after aorto-iliac revascularisations are infrequent when the operation is correctly performed and controlled by intra-operative angiography. (2) Reoperation after thromboendarterectomy is a difficult procedure requiring great care in the aortic approach. (3) Reoperation after thrombosis of a prosthetic graft is much easier as far as dissection is concerned, usually the upper part of the former prosthesis may be kept, which renders the procedure very much easier. (4) The distal anastomosis should be realised distally to the sclerotic block surrounding the femoral bifurcation. (5) In case of poor risk patients, it is better to use extra-anatomical bypasses, and if necessary, one must be able to sacrifice a limb for a life. Mortality rates are high in our series. It may be due in part to a too much optimistic pre-operative evaluation and selection of our patients, in the first years of our experience.
The authors report 22 observations of patients showing an intra-hepatic cholestasis following a traumatism. The frequency of this complication amounted to about 1.5 p. 100. Among the mechanisms of this cholestasis some factors were kept in mind: 1. the severity of the traumatism; 2. the surgical act; 3. the use of massive transfusions, the polyvisceral complications of the traumatic shock, the infectious complications. The pathophysiology of this cholestasis seems to be in relation to an increase of the production of the conjugated bilirubin. This production is associated with a decrease of the biliary excretion depending essentially on hepatic intracellular injury, secondary to: the hemorragic shock, the anoxia, the surgical intervention, the infection. From these different factors, they draw practical conclusions as much in the diagnosis of cholestasis as in the therapeutics.